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Why some communities may be at risk of lower vaccine uptake

Woman with headscarf holding a syringeData from the first wave of the pandemic showed that people from certain backgrounds and communities are at higher risk to virus prevalence and mortality, which may contribute to poorer health outcomes. When planning the rollout of the vaccination programme, it’s important to consider equality early on. We have been working as a collective with experts from across the Integrated Care System (ICS) in Lancashire and South Cumbria to assess how the COVID-19 vaccination programme could impact different population groups, and to ensure good uptake.

Vaccination programme across Lancashire and South Cumbria

For the vaccination programme across Lancashire and South Cumbria, an Equality and Health Inequalities Impact Risk Assessment (EHIIRA) was undertaken. It looked at potential impact for each of the nine protected characteristics under the Equality Act (2010) – age, race, religion, disability, sex, marriage and civil partnership, maternity, gender reassignment and sexual orientation.

We developed the EHIIRA, which is under constant review, using regional assessment work by the regional team at Public Health England.  The purpose is to highlight how the way vaccinations are delivered might impact the uptake from groups at risk, and to point out what needs to be considered.

Risk of impact

The assessment highlights considerations and equality risks for different groups. One example is black, Asian and minority ethnic communities, where we might need to think about language needs and how to establish a dialogue early on to encourage high take up.

Once the risk was raised, colleagues from the ICS set out to gain insight directly from the communities. They reached out to influential religious leaders of the Muslim community in Blackburn and Darwen, asking what we needed to think about and what we could do to get a good level of acceptance.

The result was “a significant uptake in vaccinations from eligible members of the community”, as picked up by Amanda Pritchard, NHS England and Improvement’s Chief Operating Officer, and NHS Improvement’s Chief Executive, in a bulletin to healthcare leaders on 5 February.

Potential impacts were also raised about vaccinations during the month of Ramadan, a religious festival which is celebrated by Muslims. Work is under way both locally and nationally to provide clear information about the vaccine and that the vaccine can be received during Ramadan.

Equality audits

We also developed an audit for considering equality related matters at individual vaccination sites. It examines issues of disability access, location and travel, signage and communication and religion and belief – especially relevant where religious sites were considered.

Equality assessment in Cheshire

Our equality and inclusion experts are also supporting Cheshire CCG with an ongoing assessment of how factors specific to different communities could impact vaccine uptake. For example, early on in the vaccination programme, we identified an impact for housebound patients. The only approved vaccine at the time had to be kept at very low temperatures meaning it could not be transported to their homes. To receive the jab, these patients needed to be helped into the vaccination centres, which posed further risks.

While the approval of other vaccines resolved this issue, other community characteristics continue to create impacts which could lead to low levels of vaccinations. As a result of highlighting the risk, the CCGs in Cheshire have brought in a specialist consultant to further investigate why there may be hesitancy.

The assessment in Cheshire identified potential barriers to accessing the proposed mass vaccination sites and highlighted factors such as signage, parking and welfare facilities. Local communities, such as the farming and boating communities, as well as groups with protected characteristics, were carefully considered as part of the plan for ‘hard to reach’ groups. Our advice and guidance will continue throughout the vaccination programme, supporting both mass sites and hospital hubs, GPs and pharmacies.

Equality assessment elsewhere in England

We believe the findings from the assessment in Lancashire and South Cumbria may have similarities with risks associated with equality impacts in other regions and nationally. This is why we shared the assessment template with CCGs in Leicestershire, Hertfordshire, Worcestershire, Cheshire, Wirral, Trafford, Staffordshire and the North West Regional Delivery Team.